A case of unresectable liver metastases in a patient with breast cancer is reported. Isolated abdominal perfusion chemotherapy was performed in the patient, a 48-year old woman who complained of severe abdominal pain despite receiving analgetic treatment. The perfusion was uneventful, but 3h later the patient showed dilated and light-fixed pupils. A cranial computed tomography scan revealed a massive intracerebral hemorrhage and intracerebral metastasis. Brain death developed and the patient died 26h after stop-flow perfusion. Based on this experience, any intracerebral metastasis should be considered as a contraindication for abdominal and pelvic stop-flow chemoperfusion.

Resection remains the treatment of choice in liver cancer. In order to avoid liver transplantation in conventionally unresectable tumors ex-situ (“bench” procedure), in-situ and ante-situm resection technique should be prefered whenever feasible. Despite the deficiency of donor organs, a single center experience with 198 patients reveals that liver transplantation continues its role as a therapeutic option for selected patients. At present “favorable” indications for transplantation are International Union against Cancer (UICC)-stage II hepatocellular carcinoma as well as the subtype fibrolamellar carcinoma, uncommon tumors such as epitheloid hemangioendothelioma, hepatoblastoma, and liver metastases from neuroendocrine tumors. Due to unsatisfying results, intrahepatic bile duct-, stage III and IV hepatocellular carcinoma, hemangiosarcoma, and liver metastases from nonendocrine primaries should be excluded from liver transplantation alone. For these advanced tumors, especially in cases of extrahepatic involvement, a combination of liver transplantation and multivisceral resection has been proven feasible. However, a significant improvement in patient survival may only be expected by currently investigated multimodality treatment protocols which will require further randomized studies.